There are few things that you can’t do as long as you are willing to apply yourself. –Greg LeMond
Diabetes affects more than 34 million people in the United States, and it stands to reason that many of those people work. Being gainfully employed can be rewarding and, very often, with benefits such as health insurance, a necessity. However, the workplace can add to the challenges of managing diabetes in a number of ways. Take the time to think about what your diabetes care needs are and how they affect or fit into your workday, and make sure to plan for you and your diabetes on the job.
Ideally, you will carry your blood glucose meter with you to work. This allows you to carry out your usual monitoring routine, as well as spot-check your blood glucose level if the need arises. Be sure to note the temperature range at which your meter is guaranteed to work: Most meters will work at temperatures between 50°F and 104°F; a few will operate in somewhat colder or warmer conditions. Note the temperature range given for your test strips, as well, and store test strips in their original container to protect them from light, heat and humidity. Medicines, including those used for diabetes, also have recommended temperature ranges at which they should be stored. That range should be noted on the written information or package insert that comes with your prescription.
If you work outside or in another environment that may be hotter or colder than the ideal temperature for your diabetes supplies, get an insulated bag and use a heating or cooling pack as needed.
For the protection of all the employees in your workplace, make sure you have a sharps container available to safely dispose of any lancets or needles you use during the workday. Some workplaces provide sharps containers, but if yours doesn’t, you will need to bring your own.
If you are at risk for hypoglycemia (low blood glucose), always keep items available for treatment. The best options to carry with you and/or keep at work are those that are portable, nonperishable, and do not need refrigeration, such as glucose tablets.
What is type 1 diabetes?
Type 1 diabetes is an autoimmune disorder in which the immune system attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the pancreas produces little or no insulin. Type 1 diabetes is also characterized by the presence of certain autoantibodies against insulin or other components of the insulin-producing system such as glutamic acid decarboxylase (GAD), tyrosine phosphatase, and/or islet cells.
When the body does not have enough insulin to use the glucose that is in the bloodstream for fuel, it begins breaking down fat reserves for energy. However, the breakdown of fat creates acidic by-products called ketones, which accumulate in the blood. If enough ketones accumulate in the blood, they can cause a potentially life-threatening chemical imbalance known as ketoacidosis.
Type 1 diabetes often develops in children, although it can occur at any age. Symptoms include unusual thirst, a need to urinate frequently, unexplained weight loss, blurry vision, and a feeling of being tired constantly. Such symptoms tend to be acute.
Diabetes is diagnosed in one of three ways – a fasting plasma glucose test, an oral glucose tolerance test, or a random plasma glucose test – all of which involve drawing blood to measure the amount of glucose in it.
Type 1 diabetes requires insulin treatment for survival. Treatment may also include taking other drugs to prevent kidney damage or to treat diabetes-related conditions such as high blood pressure.
Proper nutrition is important for both good health and good performance at the job. Making healthy eating a priority can be difficult, especially if your workdays tend to be rushed.
If mornings are a particular problem, get things ready the night before. Set up the coffee pot and get out any dishes or utensils you’ll need. Have a back-up breakfast plan if you are unable to take a few minutes to sit down and eat. Keep healthy, on-the-go options on hand, such as dry cereal and fruit that can accompany you on your commute. Always measure out the amount you need so you can stick with your recommended carbohydrate intake for that particular meal. It is not wise to skip breakfast for a number of reasons. One is the possibility of developing hypoglycemia if you are at risk for it. This could actually delay you getting to work since you’d need to stop and treat it.
If your workplace has a cafeteria, it may be to your advantage to get to know the cooks. Let them know you are interested in healthy eating, and ask them to share information with you — such as the Nutrition Facts panels from labels of foods served in the cafeteria — so you can make appropriate choices for your meal plan. The cooks may be willing to modify certain recipes or use lower-fat cooking techniques if you ask. Simple adjustments like putting sauces on the side and grilling instead of frying go a long way toward healthier eating. Remember to show your appreciation and let the staff know they have made a difference by helping you stay on track with your meal plan.
Off-site food options
If you don’t have a cafeteria or similar place to buy meals at your workplace, you may head out to a restaurant, deli or grocery store at mealtimes. On a regular basis, this option can get expensive and offer many challenges for healthful eating. However, you may be able to identify nearby restaurants with healthful choices or a good grocery store salad bar. Keep your meal plan in mind as you order, and aim for simple, low-fat dishes over heavily sauced meats and vegetables.
The best option for eating healthfully at work may be to bring food from home. This allows you to control what you eat, how the food is prepared and how large your portion sizes are. It may save you money, as well. To keep your food cool, use the workplace refrigerator, or purchase an insulated lunch bag and reusable freezer packs. If you have a microwave at work, you can also prepare hot meals in minutes.
Whether or not you make snacks a regular part of your meal plan, it is a good idea to keep some healthy snacks at work to tide you over when the need arises. If you have access to a refrigerator, you might choose to bring in items such as fruit, yogurt or carrot sticks. Nonperishable items such as granola bars, nuts and rice cakes can be stored in your desk or locker.
Having snacks handy will help you to avoid hitting the vending machine or eating “treats” brought in by coworkers when you’re hungry or are in a hurry. It is a good idea to prepackage your snacks into the portions you desire so you can avoid overeating, especially while preoccupied with work.
If your job includes physical labor and/or significant amounts of walking, it may be helping to keep you fit. As you know, physical activity is an important part of a diabetes treatment plan. You can evaluate the effect of your on-the-job activity on your blood glucose level by monitoring it during the day. You will benefit by keeping records of your blood glucose levels and discussing them with your diabetes care team to decide whether any adjustments, such as lowering your diabetes medicines on highly active days, are needed.
People who primarily sit at work will want to figure out when during the day they can get up and move around. Using breaks to walk up and down the stairs or walking a few laps around the building during lunch may help offset higher blood glucose levels from lack of movement while you work. Try to squeeze in at least three 10-minute sessions of moderate activity a day for a total of 30 minutes daily. When you meet with your diabetes care team, discuss the nature of your job, your activity level at work and how best to meet your physical activity goals during or outside of work.
Managing diabetes requires learning to balance the effects of eating, physical activity and usually one or more blood-glucose-lowering medicines. One of the necessary steps toward achieving this balance is learning how your diabetes medicines work — and knowing when they are likely to be working most effectively at lowering your blood glucose. This helps you to time your eating and exercise so that neither disrupts your blood glucose control. At work, however, your personal needs also have to be balanced with the needs of your job.
If you have flexibility in your schedule, try to plan meetings or intensive projects for times other than when you need to eat or perform other parts of your diabetes treatment plan. If you don’t have much flexibility, you may want to discuss your break times with your manager so they can be scheduled for times that work well with your diabetes regimen.
If you work long hours (more than 7 or 8 hours a day), you may need to plan for two meals at work, rather than just one, as well as more blood glucose monitoring, taking medicines, and finding a way to work some activity into your day.
Working an evening, night or rotating shift can be particularly challenging when it comes to diabetes control. This is in part because shift workers tend to get fewer hours of sleep overall than do people who work regular daytime hours. In addition, figuring out the best times to sleep, eat and exercise can be difficult. In general, you will still need to match your diabetes medicines to your meals, no matter when those meals occur.
It’s a good idea to speak to your diabetes care providers about managing your diabetes if you do shift work. It can also help to keep detailed written records of when you’re sleeping, eating, exercising and taking medicines and what your blood glucose levels are at these times. This can guide you and your care providers in making adjustments to your regimen.
Safety at work
Your primary workplace safety concerns will depend on the industry you work in and your occupation. If you work in an office, for example, your main concern may be the comfort of your work station. If you work outdoors, physical hazards such as heat, cold and sun exposure may top your list.
The Occupational Safety and Health Act of 1970 (OSH Act) requires employers to provide their employees with working conditions that are free of known dangers. In addition, employers have a legal obligation to inform employees of OSHA safety and health standards that apply to their workplace. Be sure you are aware of the safety policies and procedures of your workplace, and inform your employer about any unsafe conditions that you observe.
If you have any diabetes complications, you may have some special needs regarding workplace safety. For example, if you have certain types of retinopathy (an eye condition), a job that includes heavy lifting may not be advisable. If you have neuropathy that causes lack of sensation in your feet, wearing steel-toed shoes or boots may put too much pressure on your feet and cause an injury. Speak with your diabetes care providers (including any specialists you see) about your work environment and the work you do to assure that your job duties are not endangering your health or your diabetes control.
Educating your employer
While it is not required that you tell your supervisor or manager that you have diabetes, it may be wise to do so and to take the time to educate that person about how you care for your diabetes. First, assure your supervisor that you will get your job done. Then let him know what diabetes tasks you are likely to perform during the workday, such as checking your blood glucose level or taking medicines. If having your meals at set times is important to your diabetes management, let him know that, too. And if you are taking medicines that can cause hypoglycemia, explain what that means and what you need to do if your blood glucose gets too low. Explain that low blood glucose can occur unexpectedly and that if it does, you will need to briefly interrupt what you’re doing to treat it, even if that means leaving a meeting for a few minutes.
The Americans with Disabilities Act requires employers to make reasonable accommodations for employees with diabetes to permit them to perform essential job functions. The specific accommodations to be made depend on the needs of the individual. Some examples of accommodations an employee with diabetes might need include the following:
• A private area to check blood glucose or take injected medicines
• A place to rest while low blood glucose to returns to normal
• Regular breaks to check blood glucose level, eat or drink, or take medicines
Employers must always handle any information about an employee’s medical condition or disability in a confidential manner. You can learn more about your rights as an employee at the Web site of the Equal Employment Opportunity Commission, www.eeoc.gov.
If you truly feel discriminated against in the job setting, the American Diabetes Association may be able to help. See “Resources for Workers” for contact information.
Many companies are doing more with less these days, or expecting fewer employees to do the work that more people used to do. In addition, many people have lost their jobs, and among those who have found new jobs, some are having to learn new skills or to do work that does not utilize the professionals skills they have developed.
Any of these situations can be stressful, and such added stress can affect your blood glucose control. There’s no easy fix for job stress, but being aware of your emotional responses and doing your best to care for yourself emotionally and physically can help. Advocating for yourself in the workplace — by letting your supervisor know when a deadline is unrealistic, for example — and making constructive suggestions about what could be altered in the work environment may lead to positive changes.
If you are feeling down and out and can’t seem to shake feelings of sadness or irritability, are unable to concentrate or have low energy, you might be depressed and need professional help. You should seek help from your diabetes care provider or possibly from an employee assistance program, if your workplace has one.
Employee wellness programs
Some businesses have employee wellness programs in place to help their workers learn about and practice healthy lifestyle habits. Such programs may include health screenings, educational sessions, support groups, exercise groups, cooking classes, newsletters, discounted health club memberships, health insurance plans that reimburse for preventive services and other benefits. Many employee wellness programs are available to employees’ family members, as well. If your company has an employee wellness program, it’s worth checking out to see how it could help you in your diabetes care.
If your company does not currently have such a program and you’d like to encourage one, your employer can find a wealth of information on employee wellness programs that are specific to diabetes at www.diabetesatwork.org. Remind your employer that a healthy lifestyle is important for everyone, not just for people with diabetes. Studies have shown that high-quality employee wellness programs improve staff health and well-being, which may, in turn, reduce absenteeism, health-care costs and disability claims.
In addition to wellness programs, some worksites also have medical personnel on site, such as nurses, occupational medicine physicians or other health-care providers. Take advantage of these resources, and be sure to tell your diabetes care provider about any tests, immunizations (such as the flu shot), etc., that you have received at work.
Knowledge and resources
The more you know about your diabetes and your individual needs for optimal blood glucose control, the better you are able to plan for those daily needs when you are at work and to communicate them to your coworkers, if necessary. By keeping your diabetes in the best possible control, you will increase the odds for feeling better, which may help your productivity at work. (Click here for some take-away tips on managing your diabetes while at work.)
Stay in touch with your diabetes care team to make sure you are on the right track with your health. Periodically ask your diabetes care team for updates regarding your blood glucose monitoring equipment and diabetes medicines. Advances in monitoring equipment, medicines and the delivery devices for medicines used to treat diabetes may simplify your management, making it easier to incorporate these necessary health items into your daily work routine.
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